Provider Demographics
NPI:1841692555
Name:HALL, BETHEL ANNA (APRN)
Entity type:Individual
Prefix:
First Name:BETHEL
Middle Name:ANNA
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BETHEL
Other - Middle Name:
Other - Last Name:HANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 29TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1932
Mailing Address - Country:US
Mailing Address - Phone:606-225-8200
Mailing Address - Fax:888-606-7354
Practice Address - Street 1:336 29TH ST STE 203
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1932
Practice Address - Country:US
Practice Address - Phone:606-225-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16867363L00000X
KY3008890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100314870Medicaid